As part of the Affordable Care Act's efforts to reduce the number of uninsured Americans, Medicaid was expanded to cover people with income up to 138% of the federal poverty level. Although the expansion was originally intended to be enacted nationwide, in 2012, the Supreme Court ruled that states could opt out of it. In January 2018, the Trump administration issued guidance for states that want to implement work requirements for able-bodied Medicaid recipients. As states continue to consider expansion, introduce their own Medicaid work requirements, and go through litigation, we've created a Medicaid expansion monitor.